One of the most vexing issues for patients who bought individual health plans through Washington’s exchange network was the exclusion of Swedish Health Services from Premera Blue Cross’ provider networks.
On Monday, Premera announced it will bring Swedish into the fold, including all of Swedish’s hospitals, clinics and doctors in 2015 individual and small-group health-plan networks for Premera and its subsidiary, LifeWise Health Plan of Washington.
The news was well received.
“We’re happy for our patients that they have more choice in the market now,” said Tracy Corgiat, spokeswoman for The Polyclinic in Seattle.
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In the last open enrollment for individual plans, Polyclinic had to tell its patients who expected to deliver babies at Swedish’s downtown hospitals that they would not be able to do so if they signed up with Premera or LifeWise.
The Polyclinic, whose doctors typically admitted patients to Swedish, eventually worked out new arrangements with Virginia Mason, the only downtown Seattle hospital in the Premera individual plans’ network. But its obstetricians — and patients planning to deliver — were stuck, because Virginia Mason doesn’t deliver babies.
“It was the first time one of our major systems wasn’t in a popular (insurance) product,” said Corgiat.
In Clallam and Jefferson counties, individual exchange plans by Premera and its subsidiary, LifeWise, were the only choice for patients for 2014 coverage through the exchange, where they might qualify for federal tax credits and subsidies. Many patients who signed up assumed Swedish would be included in Premera’s networks, and were taken by surprise when it was not.
“I got lots of calls,” said Eric Lewis, CEO of Olympic Medical Center in Port Angeles. “(Patients asked) ‘How can Swedish not be in Premera’s network?’ ”
Adding to the pain, Olympic had forged an affiliation agreement in 2011 with Swedish, allowing its doctors to create a seamless referral for patients with serious conditions to Swedish and its specialists.
But when the new networks were formed, those doctors were left scrambling to find in-network care for patients, some of whom had to leave specialists they had seen for years. “If you’re sick or have chronic disease, you don’t want to be forced to change specialists,” Lewis said. “You buy insurance through the exchange, you expect to maintain that relationship,” he said. “You could not in 2014.”
Lewis said the mismatch was “one of the growing pains for health-care reform.” But the change, he said, is a very positive step for residents in rural areas.
Both Swedish and Premera have long said they were attempting to work out an agreement. Premera spokeswoman Melanie Coon said it took so long because Premera wanted to ensure the inclusion of Swedish wouldn’t affect plan rates.
In a statement, Rich Maturi, Premera’s senior vice president for Health Care Delivery Systems, said the deal gives Premera members “more choice and flexibility.”
And Swedish’s chief executive, Anthony Armada, said it will give patients more options, “particularly chronically ill and high-risk obstetrics patients who have existing relationships with Swedish.”
The change for 2015 also affects small-employer group plans with the Heritage Prime network.
For consumer questions about Premera’s networks, call 1-877-PREMERA (773-6372); existing members may call the customer-service number on the back of their ID cards.